Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study

Hunold, Katherine M.; Sochor, Mark; McLean, Samuel A.; B., Mosteller, Kaitlyn; Fernández, Antonio R. Martínez; Platts‐Mills, Timothy F.

doi:10.1016/j.aap.2014.09.026

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…More older adults came to the ED via ambulance than younger adults. Contrary to our expectations, recent work by our group does not support the presence of a lower threshold for ambulance transport for older adults experiencing MVC [ 51 ]. Ambulance transport can be a stressful experience for patients [ 52 ], but also provides an opportunity for prehospital treatment.…”

Section: Discussioncontrasting

confidence: 99%

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

et al. 2014

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BackgroundMotor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults.MethodsIn-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0–10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0–52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64.ResultsOlder (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults.ConclusionsIn our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.

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Section: Discussioncontrasting

confidence: 99%

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

et al. 2014

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“…Our results do not provide estimates of the 6-month prevalence of PTSD symptoms for all older adults experiencing MVC who do not require hospitalization because only about one-third of older adults experiencing an MVC receive emergency care (the other two-thirds are not treated in an ED). 50 Because pain and distress symptoms that contribute to care-seeking are also risk factors for persistent PTSD symptoms, risk for PTSD symptoms is likely lower in patients who do not seek emergency care. Non-response bias resulting from eligible subjects not consenting to participate may have led us to over- or under-estimate the percentage of older patients experiencing MVC who develop PTSD symptoms.…”

Section: Discussionmentioning

confidence: 99%

Post-Traumatic Stress Disorder among Older Adults Experiencing Motor Vehicle Collision: A Multicenter Prospective Cohort Study

Platts‐Mills

Nebolisa

Flannigan

et al. 2017

The American Journal of Geriatric Psychiatry

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Objective To characterize risk factors for and consequences of posttraumatic stress disorder (PTSD) among older adults evaluated in the emergency department (ED) following motor vehicle collision (MVC). Design Prospective multicenter longitudinal study (2011–2015). Setting 9 EDs across the United States. Participants Adults aged 65 years and older who presented to an ED after MVC without severe injuries. Measurements PTSD symptoms were assessed 6 months after the ED visit using the Impact of Event Scale-Revised. Results Of 223 patients, clinically significant PTSD symptoms at 6 months were observed in 21% (95% CI 16%–26%). PTSD symptoms were more common in patients who did not have a college degree, had depressive symptoms prior to the MVC, perceived the MVC as life-threatening, had severe ED pain, and expected their physical or emotional recovery time to be greater than 30 days. Three factors (ED pain severity [0–10 scale], perceived life-threatening MVC [0–10 scale], and pre-MVC depressive symptoms [yes to either of two questions]), predicted 6 month PTSD symptoms with an area under the curve of 0.76. Compared to patients without PTSD symptoms, those with PTSD symptoms were at higher risk for persistent pain (72% vs. 30%), functional decline (67% vs. 42%), and new disability (49% vs. 18%). Conclusions Among older adults treated in the ED following MVC, clinically significant PTSD symptoms at 6 months were present in 21% of patients and were associated with adverse health outcomes. Increased risk for PTSD development can be identified with moderate accuracy using information readily available in the ED.

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“…33,34 Our results cannot serve as estimates of the prevalence of persistent pain for all older adults experiencing MVC, because only about one-third of older adults experiencing an MVC receive emergency care. 35 In analysis of Department of Motor Vehicles data from North Carolina, females, minorities, and those experiencing more severe collisions or more severe injuries were more likely to be transported to an ED. Although we do not know, it seems likely that persistent pain is less common among older adults who experience an MVC but do not seek emergency care.…”

Section: Limitationsmentioning

confidence: 99%

Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

Platts‐Mills

Flannigan

Bortsov

et al. 2016

Annals of Emergency Medicine

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Study Objectives Motor vehicle collisions (MVCs) are the second most common form of trauma among older adults. We sought to describe the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the emergency department (ED) after an MVC. Methods We conducted a prospective longitudinal study of patients aged 65 years or older who presented to one of eight EDs after MVC between June 2011 and June 2014 and were discharged home after evaluation. ED evaluation was done via in-person interview; follow-up data were obtained via mail-in survey or phone call. Pain severity (0-10 scale) overall and for 15 parts of the body (locations) were assessed at each follow-up time point. Principal component analysis was used to assess the dimensionality of the locations of pain data. Participants reporting pain severity ≥4 attributed to the MVC at six months were defined as having persistent pain. Results Of the 161 participants, 72% reported moderate to severe pain at the time of the ED evaluation. At six months, 26% of participants reported moderate to severe MVC-related pain. ED characteristics associated with persistent pain included acute pain severity, pain located in the head, neck, and jaw or low back and legs, poor self-rated health, less formal education, pre-MVC depressive symptoms, and patient's expected time to physical recovery more than 30 days. Compared to those without persistent pain, individuals with persistent pain were substantially more likely at 6 month follow-up to have also experienced a decline in their capacity for physical function (73% vs. 36%; difference = 37%, 95% CI 19%-52%), a new difficulty with activities of daily living (42% vs. 17%; difference = 26%, 95% CI 10%-43%), a one point or more reduction overall self-rated health on a 5-point scale (54% vs. 30%; difference = 24%, 95% CI 6%-41%), and a change in their living situation in order to obtain additional help (23% vs. 8%; difference = 15%, 95% CI 2%-31%). Conclusion Among older adults discharged home from the ED after evaluation following an MVC, persistent pain is common and frequently associated with functional decline and disability.

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Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study

Cited by 6 publications

References 20 publications

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

Post-Traumatic Stress Disorder among Older Adults Experiencing Motor Vehicle Collision: A Multicenter Prospective Cohort Study

Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

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